SUMMARY AND DISCUSSION OF METHODS AND RESULTS OF THE ADULT DAY HEALTH-CARE EVALUATION STUDY

This article summarizes the study results and presents an evaluative s ummary of the implementation of study methods designed to provide guid ance in the degree of confidence with which the results may be accepte d and generalized to other situations. Patients who were offered VA-AD HC services in the first phase of this study had significantly higher VA health care costs on average than patients assigned to customary ca re, with no apparent incremental health benefit to themselves or their care givers. One can have a high level of confidence in these results . The ADHC clinical services were implemented as planned, the randomiz ed controlled trial was implemented successfully, and such threats to validity as insufficient numbers of patients and differential attritio n were not present. Certain subgroups of patients assigned to VA-ADHC had VA costs of care that were not significantly higher than those ass igned to customary care, although these results must be interpreted wi th caution. The findings of the second phase of the study evaluating c ontract ADHC provide no support for choosing to provide either contrac t ADHC or VA-ADHC over the other. The nonrandomized design and smaller sample size suggest that inferences from the contract ADHC evaluation should be drawn with more caution than those from the VA-ADHC evaluat ion.